Research Engine

RI as a scalable, research lab in a regional universe

A conversation with Dr. Jim Padbury, principal investigator and program director for the Advance Clinical Translational Research program, about the health of the research enterprise in Rhode Island

Photo by Richard Asinof

Dr. James Padbury, the program director of the Advance-CTR translational research initiative, focused on the Rhode Island research enterprise.

By Richard Asinof
Posted 6/25/18
A conversation with Dr. Jim Padbury reveals that the academic research enterprise in Rhode Island is alive, well and thriving – one in which the recognition that no one institution has all the toys, tools and talent can spur greater collaboration in a regional approach.
Why is the research enterprise in Rhode Island far below the radar screen when it comes to coverage and reporting? How will the outcomes of the ECHO studies underway in Rhode Island influence policy decisions around early childhood development, looking at environmental influences? Will concerns about protecting the safety of drinking water emerge as a political issue in the 2018 elections, particularly for women and mothers with young children? Is there a benefit to create an easy-to-access database to list all the research being conducted in Rhode Island from federal, large foundation and commercial funding? As Rhode Island makes plans for investment to create a number of innovation campuses, when will the state create an index of the Rhode Island innovation economy, to measure longitudinally, rather than anecdotally, the benchmarks of a 21st century economy?
Despite all the apparent conflict between health systems and their leadership in Rhode Island, there remains, at the working level, a remarkable spirit of cooperation and collaboration between nurses and doctors and caregivers in caring for patients. While there have been conflicts at the corporate level, the reality is that, on the ground, a culture of mutual respect and cooperation exists. The collaborative research effort being undertaken by the Advance-CTR as a Rhode Island initiative underscores those values.
On a separate note, in last week’s ConvergenceRI, in an Under The Radar Screen sidebar which criticized the myopic view by The Providence Journal of the R.I. health care landscape, it was suggested Dr. Michael Fine send his new book about the coming health care revolt to editor Alan Rosenberg. Apparently, someone at The ProJo is reading ConvergenceRI: the newspaper’s current health care reporter G. Wayne Miller reached out to Fine last week.

PROVIDENCE – When it comes to academic and clinical research in Rhode Island, Dr. James Padbury is connected, to speak in the Rhode Island vernacular. When Padbury talks about what is happening within the biomedical research enterprise in Rhode Island, it comes from an intimate, hands-on knowledge across numerous academic and clinical disciplines, including pediatrics, genomics, bio-informatics, and Big Data.

First, Padbury is Pediatrician-In-Chief and Chief of Neonatal/Perinatal Medicine at Women and Infants Hospital. He is also the William and Mary Oh-William and Elsa Zopfi Professor of Pediatrics for Perinatal Research at the Warren Alpert Medical School at Brown University. He serves as the vice chair for Basic and Translational Research in the Department of Pediatrics at Hasbro Children’s Hospital.

Padbury is the principal investigator and program director leading a five-year, $19.5 million Institutional Development Award [IDeA] from the National Institute of General Medical Sciences, a division of the National Institutes of Health, which established the Advance-CTR [Clinical Translational Research] initiative in 2016. [See link below to ConvergenceRI story, “And the winner is: Rhode Island and its innovation ecosystem.”]

Padbury is also what he calls a “bench scientist,” working on molecular biology research, focused on cardiovascular and placental development, including what he described as “the genetics around two enigmatic reproductive diseases – pre-term births and pre-eclampsia.”

And, next week, Padbury will be working at his regular month-long shift on the NICU [Neonatal Intensive Care Unit] at Women and Infants Hospital.

At the grand opening celebration of EpiVax’s new headquarters in Olneyville on June 15, when Padbury agreed to meet and talk about the advanced clinical translational research initiative, ConvergenceRI jumped at the chance, given Padbury’s extraordinarily busy schedule and expansive bandwidth. [Padbury had lent EpiVax some laboratory equipment to help facilitate the move, an example of what he called the culture of collaboration that exists in Rhode Island.]

Here is the ConvergenceRI interview with Dr. James Padbury, which took place on June 22 in the outside garden patio at Olga’s Cup + Saucer, one of those nodal points in Rhode Island’s innovation ecosystem, appropriately filled with a large number of moms and newborns in strollers.

ConvergenceRI: What are your thoughts about the selection of Dr. Atul Gawande to head the new nonprofit enterprise being set up by Jeff Bezos, Jamie Dimon and Warren Buffett to develop a new approach to health care for their more than 1 million employees?
I heard that on the NPR news this morning. I wish them well. Health care is changing quickly. I’m not sure what their plans and scope are. From my perspective, the things that I think are important in health care are regionalization.

Regionalization means every entity can’t be all things to all people. It’s better to collaborate and maximize individual expertise.

While there are pockets of centers of excellence, no one has all the toys and tools and talent, and that’s important to recognize.

ConvergenceRI: Why not choose a nurse to be head of this new enterprise? Nurses, in essence, really run the day-to-day operations of health care today [particularly in terms of primary care and prevention].
At many – if not most – hospitals, on-the-ground operations are run by nurses. I would also say there are some in nursing leadership who understand not only the operational level but also the next two or three levels up, which are integration and systems and then medicine. Each selection is situational and depends on past experience, expertise and vision.

ConvergenceRI: Have things returned to normalcy in regard to Brown’s recent, more positive view of the proposed merger between Care New England and Partners Healthcare and concerns about the potential impact on the academic research enterprise?
The Advance-CTR initiative was put together by everyone involved, so it really is an example of the whole being greater than the sum of its parts. It is a consortium of cooperation between two large academic universities, Brown and URI, three health systems, Lifespan, Care New England and the Providence VA Medical Center, and an exceptional community-based organization, the Rhode Island Quality Institute.

Everyone helped dip the oars in the water when we were putting the application together. It’s a rowing eight, there’s good balance on both sides of the boat, and everybody is pulling together well now. It is really a joyful success.

And it will not be [weakened] by the collaboration between Care New England and Partners.

From a purely health systems point of view, considering where health care is going with consolidations, mergers and acquisitions, it will be beneficial to us to have an interstate partner: a substantial portion of the clientele that we serve in my intensive care unit have Massachusetts addresses. Emergency care is not obstructed from crossing state lines.

But elective care, consultative care is. So, having a partner in Massachusetts to allow us not to be excluded from tiered levels of care by insurance carriers is important.

[Brown University President Christina] Paxson had every reasonable right and legitimate voice to make sure that what happened was beneficial to the university, the medical school, and to the people of Rhode Island.

Brown is as committed to those things as I am, as our translational research award [program] is. The MOU that has been signed reflects that [the merger] is a reasonable undertaking for Care New England, in terms of access to capital and the way in which health care is going. I think that Brown’s support for the acquisition shows that the legitimate questions being raised about transfer of tertiary [health care] services and the research enterprise had been addressed to their satisfaction.

And, that pleases me, and I think it bodes well for the future.

The Knowledge District, where we are sitting and having our coffee, will benefit from relationships formed with the large enterprises that [located] up on Longwood Avenue, in Kenmore Square, and in Cambridge.

In fact, their [future] success may be in part stifled by the difficulties in the cost of living; the run rates for enterprises up there are quite substantial. There’s every opportunity for us to work together down here, in the Wexford building, and in other ways, to collateralize some of the activities that are going on.

I would see that as a more likely outcome than things being diverted away [from Rhode Island]. I am a glass-is-half-full person.

ConvergenceRI: That is encouraging to hear; it sounds as if progress is being made in working out the collaborative framework.
I think progress is being made. What I’m saying is what leadership is saying to all of us.

ConvergenceRI: With respect to the translational research initiative, how are things going?
We just finished our second full year; we have given out more than 31 research grants; we have given out multiple stipends to allow investigators 75 percent protected time to pursue their research.

We’ve given research awards for Big Data; we’ve given out awards for grants that came just so close to the funding line. Our resubmission awards mechanism is to support grants that had been through either the large federal grants process or large foundation awards [and not quite made the cut], but would have been funded but for the funding climate in any other era.

ConvergenceRI: Is that a holdover from the decrease in NIH funding because of sequestration?
Funds are tight everywhere; the pay line at NIH has gone from the 50s to the 40s and now it is down to the 10th percentile, and/or single digits.

A pay line at 10 percent means that very meritorious research from a diversity of institutions and perspectives is going unfunded. I think NIH should strive to get itself back to the 15th or 20th percentile.

And, that’s what the resubmissions awards [through Advance-CTR] seek to do.

We have also stood up incredible resources in biomedical informatics, in biostatistics, in experimental design, and in clinical research involving human subjects.

Human subject research is becoming increasingly complex; compliance issues are becoming increasingly difficult, not as much for an old warhorse like me, but for young faculty.

Frequently, for young faculty, those administrative hoops are challenging. Thankfully, the administrative core at Advance-CTR helps them with those hoops, but it is still a challenge.

ConvergenceRI: How does the translational research initiative support collaboration?
Most science is team science now; we stipulate in our pilot grants that we give preference to applications that are multi-investigator, that show work coming from more than one discipline, from more than one domain of science, because that’s where the larger, incremental advances are going to be made.

ConvergenceRI: Within the interdisciplinary focus, how does the School of Public Health at Brown play in this?
The preparation of the application and the actual award itself was a Rhode Island application; it’s not a Brown University application.

Brown is the prime [home], because there had to be a single institutional prime [home], and in this award, they did not allow multi-PI [principal investigator] models. They said there had to be a single PI.

But I am the first to say this is a Rhode Island grant. With respect to the partnerships, every one of the constituents who you have asked about are represented in the leadership, in the daily operations, and in the future planning for these awards.

The division of Biology and Medicine, and the School of Public Health, are extremely well balanced in representation from the Brown side of things.

There is also leadership from the University of Rhode Island, and from each of the hospital systems.

It was conceived that way, the gestation proceeded that way, it was born that way, and it remains strong in that regard.

ConvergenceRI: Am I the only reporter in Rhode Island who is curious about translational research?
You are interested in process, in systems, in the institutions and the forces that are moving the community. ConvergenceRI, what is converging and emerging, I think that it is a particular niche that you occupy. I’m happy to sing the joys of translational research awards to anyone who will listen.

ConvergenceRI: I’m listening. Do you still thrive in the role of a being a catalyst, connecting people?
The drive is related to the outcomes and the successes we have had. They would only accept a single PI model, instead of a more contemporary model, where there are multiple PIs. The Associate Dean of Biology is the program coordinator, but he is, for all intents and purposes, the co-PI.

ConvergenceRI: Ed Hawrot?
Yes. Ed and I have very complementary roles. I have a foot in both the clinical world and the campus world, and Ed has a foot in the campus world as well as the clinical world.

We have an exceptional administrative staff; the Advance-CTR, honestly, runs like a startup. Any of the senior faculty could have been a PI on this grant. They ideate; we carry out their ideas. We work for them.

ConvergenceRI: Getting back to your role as a catalyst, are you still comfortable with that?
Sure, because it is fun to see these things get done. But the centrality of my role is eclipsed by the effectiveness of the administrative structure that we’ve come up with. That’s really the secret sauce. It really is.

ConvergenceRI: In terms of attracting young talent to Rhode Island, what is the best strategy moving forward?
I’m not sure why they come to Rhode Island, but I can tell you what they will find if they come here that has some uniqueness.

We’ve had this conversation before. We have a single medical school, a single department of health; we have no more complexity to our health systems and other institutions than other places.

But, because we have a single medical school, the integration of biomedical research across the health systems is as good or better than many other places.

What’s good about our system is the porosity – the ability to work with people with openness, the porosity allows for easy collaborations. The biggest challenge to collaborations on research are finding the hours in a day with other clinical obligations – how much time it takes to be able to successfully carry out a research project, and how to balance that with the clinical challenges that everyone faces.

Brown has no better or no worse solutions to that than anyone else. It is a challenge we’re facing in the Advance-CTR.

As we have finished our second full year of operation, we’re trying to come up with other models that will help us to make the lives of early career clinical scientists much easier, to help them overcome the activation energy it takes to get a project going.

ConvergenceRI: Are there other benefits to conducting research in Rhode Island?
The epidemiological benefits of having a state like this as a laboratory – because Rhode Island is a laboratory – are really substantial, from a health services and epidemiological point of view.

The fact that we have a health information exchange with the high penetration of CurrentCare [the name of the exchange], the fact that we have an All Payer Claims Database, and we have been able to negotiate relationships with the state to use the APCD in legitimate ways with appropriate safeguards for research, is exceptional.

There are not many domiciles that have such good epidemiological resources. And then we have a good bunch of basic scientists that want to do things with population-based research on a genomic and epidemiological basis. We have great cohorts of patients with pulmonary hypertension, with perinatal diseases, with infectious diseases, who are amenable to being studied with high throughput technologies, like deep sequencing [sequencing a genomic region multiple times, sometimes hundreds or even thousands of times] and genotyping, those sorts of approaches. This is a great place to conduct that kind of research.

ConvergenceRI: Is one of the attributes that make Rhode Island attractive its size – that it is small enough that you can actually find the people who you want to talk with and have access to them?
Rhode Island is not small; Rhode Island is scalable. There are nine states with smaller populations. Six of them have only three electors [two Senators and one member of the House of Representatives]. Most of them don’t have the assets we do, that I mentioned earlier, such as a single medical school. In fact, many of the states with three electors don’t have a medical school. So we have great assets.

ConvergenceRI: How are you defining scalable?
We have a population of 1 million. But, because of the assets I’ve mentioned, we have successfully competed for and won two national children’s study awards.

The National Children’s Study was an effort to enroll 100,000 mothers, infants and families from preconception across the first 21 years of life. It had troubles with execution, so it was put on hold for a while.

We were selected as a vanguard study site for Providence County, and for Bristol County, Mass., because of our regional penetration.

We now hold three ECHO awards – Environmental [influences on] Child Health Outcome studies – from NIH, for similar reasons.

ConvergenceRI: What is the content and focus of the ECHO studies? I interviewed Dr. Barry Lester a year ago, and talked a bit with him about his research work.
The ECHO awards are best described by their principal investigators. Dr. Lester’s award is following low-birth infants through the first seven years of life, looking at their developmental trajectories and gene environment interactions, epigenetics, and how those modulate the development trajectory.

Sean Deoni [a brain imaging expert] and Viren D’Sa are studying early childhood trajectories using sophisticated imaging, MRI based imaging, [to look at how environmental exposures affect childhood brain development, in collaboration with Joseph Braun, an assistant professor of epidemiology].

Dr. Phyllis Dennery, [the Sylvia Kay Hassenfeld Professor of Pediatrics at] Hasbro Children’s Hospital, is the principal investigator for a third ECHO award, along with Drs. Abbott Laptook and Thomas Chun, to create a pediatric clinical trial network that is one of 17 in the country, to enroll patients from less well-resourced areas to bring them opportunities [to participate] in clinical trials.

Being in a community where clinical research is taking place is an exceptional benefit to the community and participation is always with appropriate safeguards.


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